Hybrid revascularization of chronic limb-threatening ischemia using popliteal below-knee and tibial trifurcation open endarterectomy distally plus inter-woven nitinol stenting proximally.

OBJECTIVES: Chronic limb-threatening ischemia (CLTI) is frequently due to multilevel, heavily calcified lesions, and it is often associated with desert foot. Effective revascularization currently presents an additional challenge due to the increasing age, comorbidities, and frailty related to these patients. Pure endovascular treatment often fails to achieve effective and durable revascularization and it is associated with still high amputation rates. We present a novel hybrid approach and discuss its usefulness for limb salvage in complex infrainguinal lesions. METHODS: Two no-option patients for both anatomical and medical-comorbidity reasons, were treated consecutively for CLTI. Both of them had prior failed percutaneous endovascular treatment, and bypass revascularization had been ruled out. We describe the technical details of an aggressive, but still less invasive hybrid approach, consisting of open distal popliteal artery (PA) and tibial trifurcation endarterectomy plus patch angioplasty, associated with proximal endovascular treatment with inter-woven nitinol stent from the superficial femoral artery (SFA) to the endarterectomized area. RESULTS: Technical success and salvage of the affected limb were achieved in both cases, presenting significant postoperative clinical and hemodynamic improvement and allowing early discharge hospital at home. There was no surgical wound infection or other complications. CONCLUSION: This hybrid approach through a single incision is safe and effective in the short term and can be used with excellent results for CLTI in high-risk and /or no-option patients.

Abdominal Aortic Rupture Secondary to Lymphoma Recurrence.

Neoplasias affecting the aorta are usually due to a variety of thoracic and abdominal tumors, which are more common than primary tumors of the aortic wall. Those tumors that can invade the abdominal aorta are usually sarcomas, which are able to mimic, both clinically and radiologically, an aortic disease such as an aneurysm or a dissection. There are few clinical scenarios where surgical resection and aortic repair needs to be performed, and indications have not still been clearly established in the literature. We describe the case of a patient with a periaortic lymphoma who presented an aortic rupture and was successfully treated with an urgent endovascular repair.

Efficacy of bosentan in digital ischemic ulcers.

Thromboangiitis obliterans (also known as Buerger's disease) is an inflammatory vascular disorder that affects small and medium-sized arteries and veins in the extremities. There is no specific treatment and the only effective intervention is absolute cessation of tobacco use. Endothelial dysfunction appears to be of relevance to this condition and a report has even found that high serum levels of endothelin correlate with the presence of necrosis. We report two cases of digital necrosis showing a very satisfactory response to treatment with bosentan, a dual endothelin receptor antagonist.